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HMS, TIP 2019 HSC 30a

An athlete dives towards the ground in an attempt to score a try in a game of touch football. The athlete hears a loud crack and remains on the ground, clutching the injured shoulder.

  1. Explain the assessment procedures that should be used to determine the nature and extent of this injury.   (4 marks)

  2. Describe the management of fractures and dislocations.   (4 marks)

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i.    TOTAPS assessment

  • TOTAPS assessment provides systematic evaluation of the shoulder injury. Talk involves questioning the athlete about pain location, intensity, and mechanism of injury. This determines initial severity and helps identify potential fracture or dislocation.
  • Observe compares the injured shoulder to the uninjured side for deformity, swelling, or abnormal positioning. This reveals obvious structural damage or displacement indicating serious injury requiring immediate medical attention.
  • Touch assesses tenderness, heat, and structural abnormalities through gentle palpation. This identifies specific injury location and severity. However, if significant deformity or severe pain exists, assessment should stop immediately.
  • Active and passive movement testing would not proceed due to suspected hard tissue injury. This occurs because movement attempts could worsen fracture displacement or joint damage, requiring immediate medical intervention instead.

ii.   Management of fractures and dislocations

  • Fractures require immediate immobilisation to prevent further tissue damage and reduce pain.
  • Support the injured area using splints, slings or bandages without attempting realignment.
  • Monitor for shock symptoms including pale skin, rapid pulse and decreased consciousness.
  • Transport to medical facilities immediately for professional treatment including X-rays and surgical intervention if required.
  • Dislocations involve joint displacement requiring professional medical reduction.
  • Never attempt to relocate the joint as this may cause additional nerve or blood vessel damage.
  • Immobilise the joint in the position found using appropriate supports.
  • Apply ice to reduce swelling and pain while monitoring circulation below the injury site.
  • Arrange immediate medical evacuation for proper diagnosis and professional joint reduction procedures.

Show Worked Solution

i.    TOTAPS assessment

  • TOTAPS assessment provides systematic evaluation of the shoulder injury. Talk involves questioning the athlete about pain location, intensity, and mechanism of injury. This determines initial severity and helps identify potential fracture or dislocation.
  • Observe compares the injured shoulder to the uninjured side for deformity, swelling, or abnormal positioning. This reveals obvious structural damage or displacement indicating serious injury requiring immediate medical attention.
  • Touch assesses tenderness, heat, and structural abnormalities through gentle palpation. This identifies specific injury location and severity. However, if significant deformity or severe pain exists, assessment should stop immediately.
  • Active and passive movement testing would not proceed due to suspected hard tissue injury. This occurs because movement attempts could worsen fracture displacement or joint damage, requiring immediate medical intervention instead.

ii.   Management of fractures and dislocations

  • Fractures require immediate immobilisation to prevent further tissue damage and reduce pain.
  • Support the injured area using splints, slings or bandages without attempting realignment.
  • Monitor for shock symptoms including pale skin, rapid pulse and decreased consciousness.
  • Transport to medical facilities immediately for professional treatment including X-rays and surgical intervention if required.
  • Dislocations involve joint displacement requiring professional medical reduction.
  • Never attempt to relocate the joint as this may cause additional nerve or blood vessel damage.
  • Immobilise the joint in the position found using appropriate supports.
  • Apply ice to reduce swelling and pain while monitoring circulation below the injury site.
  • Arrange immediate medical evacuation for proper diagnosis and professional joint reduction procedures.

♦♦♦ Mean mark (ii) 48%.

HMS, TIP 2023 HSC 30a

Refer to the following scenario to answer BOTH Questions 30 (a) (i) and (ii).

An athlete tries to change direction quickly to evade an opponent during a basketball game. They hear a loud snap and feel their knee give way beneath them, sustaining knee ligament damage.

  1. Outline TWO classifications of this injury.   (3 marks)

  2. Explain the process for determining the nature and extent of this injury.   (5 marks)

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Sample answer

i.   Injury classifications

  • An indirect injury as it resulted from internal forces when the athlete tried to change direction, rather than from direct external impact.
  • A soft tissue injury since ligaments are connective tissue rather than bone, with damage occurring to the structural components that stabilize the knee joint.

ii. Assessment of nature and extent of the injury – TOTAPS

  • The TOTAPS assessment begins by talking with the athlete about injury mechanism and symptoms. This communication reveals critical information about the snap sound and knee instability because these details indicate potential ligament rupture severity. Questioning establishes pain location and movement limitations which helps identify specific structures involved.
  • Observation follows because visual indicators reveal injury extent through swelling, bruising, or deformity patterns. These signs demonstrate ligament damage severity and guide subsequent assessment steps. Touch assessment then occurs to pinpoint specific pain sites along knee ligament pathways. This palpation process identifies which structures like ACL or MCL are damaged because tenderness patterns correspond to anatomical locations.
  • Active movement testing enables the athlete to attempt limited knee flexion and extension. Range restrictions occur due to ligament injury and muscle guarding which indicates functional limitations. Passive movement assessment involves careful knee manipulation including anterior drawer tests. These specialised tests determine ligament stability because abnormal movement patterns reveal structural compromise. Skills testing becomes contraindicated because obvious instability creates risk for further damage to compromised ligaments.

Show Worked Solution

Sample answer

i.   Injury classifications

  • An indirect injury as it resulted from internal forces when the athlete tried to change direction, rather than from direct external impact.
  • A soft tissue injury since ligaments are connective tissue rather than bone, with damage occurring to the structural components that stabilize the knee joint.

ii. Assessment of nature and extent of the injury – TOTAPS

  • The TOTAPS assessment begins by talking with the athlete about injury mechanism and symptoms. This communication reveals critical information about the snap sound and knee instability because these details indicate potential ligament rupture severity. Questioning establishes pain location and movement limitations which helps identify specific structures involved.
  • Observation follows because visual indicators reveal injury extent through swelling, bruising, or deformity patterns. These signs demonstrate ligament damage severity and guide subsequent assessment steps. Touch assessment then occurs to pinpoint specific pain sites along knee ligament pathways. This palpation process identifies which structures like ACL or MCL are damaged because tenderness patterns correspond to anatomical locations.
  • Active movement testing enables the athlete to attempt limited knee flexion and extension. Range restrictions occur due to ligament injury and muscle guarding which indicates functional limitations. Passive movement assessment involves careful knee manipulation including anterior drawer tests. These specialised tests determine ligament stability because abnormal movement patterns reveal structural compromise. Skills testing becomes contraindicated because obvious instability creates risk for further damage to compromised ligaments.

♦ (ii) Mean mark 51%.